Randomized trial of a noninvasive strategy to reduce hospital stay for patients with low-risk myocardial infarction

• Published in: Journal of the American College of Cardiology Vol. 37; no. 5; pp. 1289 - 1296
• Main Authors: Bogaty, Peter, Dumont, Serge, O’Hara, Gilles E, Boyer, Luce, Auclair, Lucie, Jobin, Jean, Boudreault, Jean-Roch
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.2001; Elsevier Science
• Subjects: Adult; Aged; Biological and medical sciences; Cardiology. Vascular system; Coronary heart disease; Electrocardiography, Ambulatory; Feasibility Studies; Female; Follow-Up Studies; Heart; Hospital Mortality; Humans; Length of Stay - statistics & numerical data; Male; Medical sciences; Middle Aged; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Prospective Studies; Risk Factors; Survival Rate; Treatment Outcome; CK; ECG; MI; Human; Treatment; Hospitalization delay; Infarct; Myocardium; Cardiovascular disease; Evolution; Coronary heart disease; Myocardial disease
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(01)01131-7

OBJECTIVES This study evaluated the feasibility, pertinence and psychosocial repercussions of a noninvasive reduced hospital stay strategy (three days) for low-risk patients with acute myocardial infarction using simple clinical criteria and predischarge 24-h ambulatory ST-segment ischemic monitoring. BACKGROUND Previous studies evaluating shorter stays for uncomplicated myocardial infarction have been limited by retrospective or nonrandomized design and overdependence on invasive cardiac procedures. METHODS One-hundred twenty consecutive patients admitted with an acute myocardial infarction fulfilling low-risk criteria were randomized 2:1 to a short hospital stay (80 patients) or standard stay (40 patients). Short-stay patients with no ischemia on ST-segment monitoring were discharged on day 3, returning for exercise testing a week later. All analyses were on an intention-to-treat basis. RESULTS Forty-one percent of all screened patients with acute myocardial infarction would have been medically eligible for the short-stay strategy. Seventeen patients (21%) were not discharged early because of ischemia on ST-monitoring or angina. Median initial hospital stay was halved from 6.9 days in the standard stay to 3.5 days in the short-stay group. At six months, median total days hospitalized were 7.5 in the standard stay and 3.6 in the short-stay group (p < 0.0001). Adverse events and readmissions were low and not significantly different, and there were 25% fewer invasive cardiac procedures in the short-stay group. Psychosocial outcomes, risk factor changes and exercise test results were similar in the two groups. CONCLUSIONS This reduced hospital stay strategy for low-risk patients with acute myocardial infarction is feasible and worthwhile, resulting in a substantial and sustained reduction in days hospitalized. It is without unfavorable psychosocial consequences, appears safe and does not increase the number of invasive cardiac procedures.